EVALUATION OF TREATMENT FOR CONGESTIVE-HEART-FAILURE IN PATIENTS AGED60 YEARS AND OLDER USING GENERIC MEASURES OF HEALTH-STATUS (SF-36 ANDCOOP CHARTS)

Objectives: to assess the functioning and well-being of older patients presenting with congestive heart failure (CHF) using established gene ric health status measures-the short form 36 health survey (SF-36) and Dartmouth COOP charts. Methods: patients aged GO or older with CHF we re asked if they would take part. They were requested to complete inte rviewer-administered questionnaires before angiotensin converting enzy me (ACE) inhibitor treatment and at follow-up 4 weeks later. The inter viewer administered the SF-36, COOP charts, the oxygen cost diagram an d also asked patients to assess their health state overall and, after treatment, to assess changes, if any, in overall health. Results: mult i-dimensional health status measures indicate that patient's functioni ng and well-being is substantially compromised by CHE especially in ar eas relating to physical functioning, and that treatment with ACE inhi bitors has only limited effect in improving health-related quality of life. However, on simple single-item global assessments of health, pat ients report that their overall health-related quality of Life is good and many report improvements in overall health status at follow-up, C onclusions: ACE inhibitor treatment, whilst lengthening life, has a re latively limited impact on its quality. While multidimensional health status measures indicate CHF to be associated with poor health as meas ured by the SF-36 and COOP charts. However, when patients are asked si mple single-item questions relating to their overall health state and the extent of change experienced after treatment, they report relative ly good health and positive improvements as a consequence of therapy. Since elderly patients' expectations of improvement may be modest and their expectations of physical ability relatively limited, relatively small improvements. which may not appear large when reported in effect size statistics, may be important. Standardized questionnaires, and s tandardized statistical methods of assessing change, may not be approp riate for this patient group. A fuller understanding of their expectat ions and assessment of treatment outcomes is necessary.